NBME 24 Discussion of the diagnosis with the patient privately (NBME Answers)

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Retired NBME 24 Answers

nbme24/Block 3/Question#13 (reveal difficulty score)
An 83-year-old woman is brought to the ...
Discussion of the diagnosis with the patient privately 🔍 / 📺 / 🌳 / 📖
tags: syphilis ethics repeat

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submitted by ∗peqmd(75)

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nqetiuos is iagkns w'stah teh etsb exnt etsp tno yseeclirasn hwat is the btse dgciotnasi ,etsp chwhi is mwahesto of Step 2 irotonat flshe eonsiuqt (orf leppeo who teksa Stpe 1 ftare t)iotnasr.o R,DTL stbe NTXE pset si tlka to ehr isftr ta mmnmiui oyu eedn ot eemrtendi if she hsa ci.aypcta

ehWil eht pntiaet sha retpyt abd SE:MM

.B sI the btse tnex ptse. oYu ened to dscisus tihw ehr .sfitr tg&;= ieenrmedt ehr siiedcno kgmani ytccaipa t&g=; nthe dcpreoe hretwhe ot iscsdsu whti hre uahtegdr A)(.

Lmubar tpeunucr is eth etbs cisadgtion epst. ,wvoHere in shit qtinuoes 'hyrtee ksagni uyo hwat oyu eedn ot do to vene pdoeerc to isth setp. Ie.. tge erh tayipcca tenh uoy nca opecerd to .uabrlm ishT is sbceuea blmrua cntuepru is more ienvaivs adn 'oluly ndee ot sesass atapycic sa lewl sa gte terieh erh (fi esh sah cy)iapcat ro augdt.her

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submitted by centeno(3)

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I ugtthoh ahtt eht ogvicietn merpiatmni cudlo be eht taantieofsnim of lnspyhesi.oiru In oiiadd,tn eht tdcroo uolsdh atlk tlidreyc ot het iptnaet to hekcc rof uaelsx base.u

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j44n Teh muammxi MMES creso is 03 tsp.oni A rosce of 02 to 24 eusgtgss imdl ae,temdni 31 ot 02 tesugssg moredate mtnd,iaee dan lses hatn 21 actsdiein vesere mndei.eta On ,vegeara het MMES osrec of a srpneo thwi Aleimhszr'e sliednce baout wot to ufro tsipon heca e sy.eahr olyn ahs dlim .mtandeie I ahd to okol itsh up hes cdlou ltlis arinte ehr acpycati +1

All patients, including those with dementia, should be assumed to possess the decisional capacity to make medical decisions unless the physician determines the patient does not possess decisional capacity.

+/- namesthegame22(13)

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submitted by ∗lispectedwumbologist(122)

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Cna yodbyna elanpix tihs no?e I put edapreet etsts cuaeseb I muesdsa an eo-y83al-dr amown is an uulanus iochrpgdmae ofr .hisipsyl

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m-ice 83 migth seme na unnocomm e,ag btu we o'ndt nowk fro seur erh uxseal yris.tho hSe noyl ryceltne (8 mnshto )gao tdesrta ghoisnw seom isnsg fo ldmi iicngovet .rmatipinme Seh ash all sehet ltrsesu ipimgnyl thta hse has hyisispl, os eht toms llyike sawrne is ahtt seh sah hisiyp,ls so we husodl akesp to her yptlrviae oatub reh slxuea oris.thy ehT tests odt'n csreiesnlay emsan she gto lyhpsisi eyvr cetlen,yr t'is siseoplb sse'h dah hlssyiip orf a ilehw adn eenvr otg etae.rdt +5

mousie I dnrdaunste that esh olcud syspibol haev liihsspy tub I lsao utp epatre esstt eaebusc I nwok ehrte ear a wfe hntgis taht cna aeucs afels otpvsiei sDRVL btu fi ehs slao hsa a + RPR eods isht keam a FP less leiy?kl ndA aosl if hes sha dmil tovciineg inrpetmiam yuo iltsl susicds tiwh hre otn ehr uadethgr eoccrrt ?... +4

m-ice Tihs nieyftleid oudcl eb a safel o,stevpii tbu oberef we twna to scneodri ti ot eb a lseaf eps,oiitv ew usldoh lkta to the pitaetn tobua it retayvp.li mssiAung hatt tsi' a fesal pitesoiv erfboe ganiks eht titeanp obtua ti cloud alyed rtetaentm fo erh hsispy.li heer'sT a nhecac seh 'nitdd atwn to iseoldcs her alxuse tosyihr ni fntor fo reh dguehtra ro beyma hes aws rdesamerabs ro tddin' nkthi it swa apimrtont ot nnniteo Ad.m 'ourey yluleabsot h,gtir hse noly sah mlid igivneoct e,rimmtinpa so ew omst etlfineyid dosluh katl ot het aetptin naelo hiuwott rhe hdrugtea .rtfis +4

seagull heS ahs tnie.aedm hSe no'dets haev teh iytacapc ot nerdmetei ehr now ecra (2023/ M)M.E I flee the agurthed dhsluo vahe het owrd on hte ecar escin Garndam klylei desn'ot avhe hte tcaapcyi ot tsenndruda erh ncs.itoa +5

sajaqua1 Fmor what I bmreme,re meteinda is yplctlayi a otoiinnbcma of piaerimd ermymo *da*n pimidrae oguthth spceses.ro eTher is hoitngn ot ienictad ttha eht pentiat sha iemipdar uohghtt spsrc,eeos adn the yromem einmrmptia si loyn ldm.i heT pnieatt anc llsit arsoalnbey idsa ot eb oetenm,pct and so ehr prevtia fiainoonmrt uhlosd be sudsdecis hwit ehr aleno. +12

yotsubato eldrE aecr hsoem or eelryld tsuencmomii aulatylc ahve a ihhg erta of T.sDS ursTn ut,o wenh uoy ptu a cubhn fo ddi/dcwrediooewv asldut eohegrtt in a ommyinuct they vhae .xse +12

yotsubato Ayilidlandot, yuo uodhls stcerep the virycap fo a ptctmonee ladtu thiw li"Md "oymemr pmianter.mi I ownk I oldcu ehva ildm emroym maipnrmeti eidsignncor eth rcpa I froetg gsuidtny rof epts 1 +14

drdoom sallgeu@ deaitnem ≠ ncsbeea fo ceneomtpec -- teh otw are eaerpast occesptn dan veah to eb ltaeauedv deinpdt.eynnle ese 3pumsgnimdv.rDlt?///tihhceu=r407e.iso0.n0boh:/ dan .4ud7/Dre6o/c?i3u.=/oetv0bgslthnmhpr:ms/nh.ii1 +3

wowo oasl poiatmtrn ot e,nto )d aeeretpd tstes si asol rerocntic as het oiiergtmmoauinghcnalt syaas si a ciaoofmtrynr ltermonepa tets lga(no het same islne as A-BSFTA) tbeior/h./rhh/emga.:ltat5prfwwwhs/3l8authoy9hlw- +5

sunshinesweetheart ..a.o.sl I ihtkn we cna umessa hatt "tdeepaer stes"t neasm eerapt VLD,R not tinaoldaid" sstet to rlue uto selaf i"tspvoies +2

imtiredofstudying eht eenitr ipnot of ihst osuenqit si htta nwhe uoy ese an SDT ni na eetcpdnuxe premgdhcaio crhi(,dlne d,re)leyl TIKHN LESUXA EUSAB +

23 of 30 is mild dementia by DSM V , still has capacity to answer basic questions , and STD in childs and elderly ALWAYS think ABUSE FIRST

+2/- usmlecrasherss(27)

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submitted by ahd_ve(7)

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eth amni ogal rfo htis etoqsnui is advio guissdcins seuiss htwi ritseelva utohtwi eht aitetnp’s menssr.pioi tub oesm loepep ewre pleeyd hsedcok ot ees atth a hdmrrnatoge ash ys.siplhi wtB I evael a nikl fo a hrecsaer tubao aiCncill yttiUli of eth ln-aMtneiiM Stsuat iimnonaatxE nWeh Angesssis ak-nngicoiDseMi c.Ctapyi a/lesot0:1p8s1c9u.7atss/88/a7o1d27hnba0ru.2/pg734m9j70/1.bi/9o

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submitted by komodo(4)

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I itkhn oen fo the oisnsufcno hree is ttha eth ihtrmmlcauitnigonogea saays o'sndet easinclseyr acteinid nrcrteu inoftcnie hitw i,hslspiy cabeeus tpoeemlanr setts anc ytsa oiietsvp veen fro sayre aretf temtatner (scob20Pnv/n.i/l/9hpicti0/m.pas2/5t.egmrtlh:MC0ww/w.nc Thta) in omobc twih eth veyr wol PRR tiert loduc cniatdei tdreeta ipyilhs.s So laylre hte bset ihgtn ot od oulwd be to aks eht naettip etcydlri tobua it obeerf you aestw tmei iogdn soylspbi sneauecnsry tnestgi da(n I woldu eytdfelnii ask rhe riyclted secin tmos peelpo no'td altk btoua tiehr TsSI itwh threi rldiehcn)

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submitted by ∗deathbystep1(21)

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ooinpt B) he(t etoccrr pnooti sa pre )mneb et:h eaptnti hsa a iinm alnetm attes fo ,2033/ os atth slodhu emna hatt hes nist' plabeac fo akgmni her onw oins!dcise os haswt teh nptio in gtliank ot her elvapriyt iotuthw rhe ?eagdrthu

oipton A) si ngowr caueesb ouy cant ujts idhe het soiiagsnd rfmo het tpitnea dan sareh it whti eth imlyfa

nptoio C mpa&; oDy)u oacnnt erardgisd eth tste ro aertep eth ttes as ohtb eht etts ear ivspeio,t RPR is a cserniegn stet wtih lses fiitpisccye tbu rncighmoaotgaeiimutnl is a ygihhl cipcesfi estt so she lenyiefdt sha slylihp!is

ponito E) etndso kmae snees ausceeb wyh dowlu ouy do marblu trupnecu fro ls?sil!phiy

i nktih tyhe ogoftr to evgi an oioptn F) tujs iferakn ttrea erh fro is!sylhpi!!l

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saturdaynightpalsy "naiPstet thiw pucsedset eyspuhisrnloi dolhsu dgnoeur ubrmla rcutuepn nad ssunbqetue ,VDLR -SAABFT da/onr PRC of bnerclsieropa ifuld" epr ym tnseo adn hte trmnebtniru eaL rencuput is esud ot oedginas pn,eolysiiruhs so 'ahtst wtah I p.ut +2

saturdaynightpalsy oT dad to tah,t I tddin ceoosh eth eroth srwanes you sdetil orf the same resosan uyo itlsd.e +1

ac3 chhiw of the fonwlilog is eth XTEN EBTS ETSP geinmna uoy ntwluod tanw ot pjmu gtastirh ot a lurmab ptucneur seycelilap wenh hrtee rea sernwa csoechi ahtt gsgsute isisguscnd het sigdsnoia ihtw hte aptniet .irfts fI uyo ewnt ot eht odrotc nad yhte ngediaos uyo they lwli usdicss hsti thiw uoy rfeeob ridngreo nliaaddoit tit.ensg +1

yerpderp 203/3 is slao ujst mdli ecivtingo rmamteinip so I tujs tohhutg hse isllt dah iocedsin amgkni tibcaialpy sa 243/0 si ilstl rmoanl +3

cbreland reA we dcetxpee to rirettpne MIC sersoc +

madamestep lMid omyrme iaerpntmim oesd TON nema aedesecdr -connkdeasimgii paia.ctcy An 38 raye ldo wthi an asltom lrmano tnalme utssta emax woh baemy ash a wen ebrinfoyd ta ehr grnsniu ohem baybplro ulotnw'd ntwa her terhudag ot nkow thta ehs ahs an TIS. And fi sthi si erlde ,asbue oyu'd olas twan ot ltak to rhe elitavyrp to see fi 'essh .eafs oN mteatr ahtw, roled ldstua whit mldi atnimeed rea ltsli naolrm peleop nda uyo eedn to asesss erthi giieadocis-mknn cyaaicpt iioncdse ot so.ceiidn hsTi amnwo most elylik ash hte capaiytc ot eddcie if hes nsawt ot odnruge lhyspiis t.nemtreat +

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